- Starts classically with diffuse abdominal pain felt most prominently in the periumbilical area.
- There is anorexia and nausea.
- Vomiting may follow.
- Pain then settles in the right lower quadrant and is localized at McBurney’s point.
- The pain may be relieved briefly after perforation but is accentuated by the ensuing diffuse peritonitis.
- There is localized tenderness in the right lower quadrant,
- Rebound tenderness
- Muscle guarding
- Cutaneous hyperaesthesia
- Pelvic tenderness in the right iliac fossa on rectal examination.
- Rovsing’s sign may be positive and the temperature may be elevated.
Laboratory examinations are not critical for diagnosis. There is leucocytosis with neutrophilia. Normal values do not rule out appendicitis, however.
- Initiate appropriate resuscitation.
- Once diagnosis is made, give analgesics whilst preparing for surgery.
- Starve the patient before surgery
- Give premedication when there is time (atropine 0.6mg IM stat and morphine 10mg IM stat).
- Appendectomy is the treatment of choice, once a definitive diagnosis is made.